The monitoring system demonstrates a consistent pattern of independent medical examiners (IMEs) failing to adhere to the ABIME’s established quality assurance protocols for medical evaluations. This scenario is professionally challenging because it directly impacts the integrity and reliability of the independent medical evaluation process, which is foundational to fair claims adjudication and patient care decisions. Ensuring consistent quality across a network of examiners requires robust oversight and a commitment to continuous improvement, balancing efficiency with thoroughness. The best approach involves a multi-faceted strategy that prioritizes direct examiner engagement and targeted remediation. This includes conducting regular, random audits of a statistically significant sample of completed evaluations to identify systemic or individual deviations from ABIME standards. When deficiencies are identified, the process should involve providing specific, constructive feedback to the examiner, referencing the exact ABIME guidelines or ethical principles that were not met. This feedback should be coupled with a requirement for the examiner to complete remedial training focused on the identified areas of weakness, followed by a period of heightened monitoring to ensure improvement. This approach is correct because it directly addresses the root cause of quality issues by educating and supporting the examiner, while also maintaining accountability through auditing and follow-up. It aligns with the ethical imperative to ensure competence and the ABIME’s commitment to maintaining high standards of practice. An approach that relies solely on a high volume of random audits without providing specific feedback or remedial support is insufficient. While audits identify problems, they fail to address the underlying reasons for non-compliance and do not equip the examiner with the knowledge or skills to correct their performance, potentially leading to repeated errors and a lack of improvement. Another unacceptable approach is to only address quality issues when a formal complaint is lodged by a claimant or payer. This reactive strategy is inadequate because it means that numerous substandard evaluations may go undetected, potentially causing harm or injustice to individuals before any corrective action is taken. It also fails to proactively uphold the ABIME’s commitment to quality assurance. Finally, an approach that focuses exclusively on disciplinary action, such as immediate suspension or termination, for any identified deviation, without first attempting education and remediation, is overly punitive and counterproductive. While serious breaches may warrant such measures, a blanket policy of immediate disciplinary action fails to acknowledge that many quality issues stem from misunderstanding or lack of training, and it misses opportunities for professional development and retention of competent examiners. Professionals should employ a decision-making framework that begins with understanding the specific quality assurance requirements of the ABIME. When monitoring reveals deviations, the first step should be to gather objective data to confirm the pattern and identify the nature of the deficiencies. This data should then be used to inform a structured communication with the examiner, focusing on education and collaborative problem-solving. The goal is to foster an environment of continuous learning and improvement, ensuring that all evaluations meet the rigorous standards expected by the ABIME and the stakeholders who rely on them.

This scenario presents a professional challenge because the independent medical examiner (IME) must reconcile potentially conflicting findings from different diagnostic modalities while adhering to the ABIME’s ethical and professional standards for independent medical evaluations. The core difficulty lies in interpreting anatomical and physiological data in the context of a specific condition and presenting an objective, evidence-based opinion that is not swayed by the patient’s subjective complaints alone or by the limitations of a single diagnostic tool. Careful judgment is required to ensure the evaluation is comprehensive, accurate, and defensible. The correct approach involves a thorough synthesis of all available information, prioritizing objective findings from diagnostic imaging and physical examination over subjective patient reports when there is a discrepancy, and then correlating these objective findings with the patient’s reported symptoms and functional limitations. This approach is correct because it aligns with the ABIME’s emphasis on objective evidence and the physician’s duty to provide an unbiased assessment. By integrating imaging, physical exam, and patient history, the examiner can form a well-supported conclusion about the underlying anatomy and physiology contributing to the condition, thereby establishing a credible basis for disability or impairment ratings. This method ensures that the opinion is grounded in established medical science and the specific findings of the examination, rather than speculation or undue reliance on subjective reports. An incorrect approach would be to solely rely on the patient’s subjective report of pain and functional limitations without adequately correlating it with objective findings from the physical examination and diagnostic studies. This fails to meet the standard of an independent medical evaluation, which requires objective substantiation of the claimed impairments. Another incorrect approach would be to overemphasize findings from a single diagnostic study, such as an MRI, without considering the clinical context, physical examination, and the possibility of incidental findings or limitations of that specific modality. This can lead to an inaccurate or incomplete assessment of the patient’s condition and its impact. Finally, an approach that dismisses objective findings because they do not perfectly align with the patient’s subjective complaints, without a reasoned explanation for the discrepancy, is also professionally unacceptable. This demonstrates a bias and a failure to conduct a comprehensive and objective evaluation. Professional reasoning in such situations requires a systematic process: first, meticulously review all provided records and conduct a thorough physical examination. Second, critically analyze all diagnostic imaging and test results, noting both positive and negative findings. Third, correlate these objective findings with the patient’s reported symptoms and functional limitations, seeking to understand how the observed pathology might explain the reported experience. Fourth, if discrepancies exist, attempt to reconcile them through further clinical reasoning or, if necessary, recommend additional objective testing. Finally, formulate an opinion that is clearly articulated, evidence-based, and directly addresses the questions posed in the referral, with a clear explanation of the anatomical and physiological basis for the conclusions drawn.

Scenario Analysis: This scenario presents a professional challenge because it requires the independent medical examiner (IME) to navigate the complex intersection of medical expertise and legal procedure. The IME’s role as an expert witness demands not only accurate medical assessment but also the ability to communicate findings clearly and ethically within the adversarial courtroom environment. Maintaining objectivity, adhering to discovery rules, and avoiding undue influence from legal counsel are paramount to upholding the integrity of the expert opinion and the judicial process. The pressure to present findings in a manner favorable to the retaining party, while remaining truthful and unbiased, creates a significant ethical tightrope. Correct Approach Analysis: The best professional practice involves the IME meticulously preparing their testimony based solely on their independent medical evaluation and objective findings. This includes reviewing all relevant medical records, ensuring their report is comprehensive and accurate, and anticipating potential cross-examination questions by practicing clear, concise, and truthful answers. The focus remains on presenting the medical facts and their interpretation without embellishment or omission, and without adopting the legal strategy or advocacy of the retaining attorney. This approach aligns with the ethical obligations of an expert witness to provide impartial and scientifically sound testimony, as expected by the court and governed by rules of evidence and professional conduct. Incorrect Approaches Analysis: One incorrect approach involves the IME allowing the retaining attorney to extensively script their testimony, including specific phrasing and responses to anticipated questions. This compromises the IME’s independence and risks presenting testimony that is not a genuine reflection of their professional opinion, but rather a legal construct. This violates the ethical duty to provide unbiased expert opinion and can lead to impeachment during cross-examination, undermining the credibility of both the witness and their report. Another unacceptable approach is for the IME to agree to tailor their findings or conclusions to align with the desired outcome of the case, as suggested by the attorney. This constitutes a direct breach of professional ethics and potentially legal standards for expert testimony, as it prioritizes advocacy over objective medical assessment. Such actions can result in sanctions, loss of credibility, and damage to the professional reputation of the IME. A further flawed approach is for the IME to refuse to review or consider any medical records or evidence that might contradict their initial findings or the narrative favored by the retaining attorney. This demonstrates a lack of thoroughness and a failure to conduct a complete and objective independent medical examination. It also suggests a bias that is antithetical to the role of an expert witness, whose duty is to present a complete and accurate medical picture, including any nuances or counterpoints. Professional Reasoning: Professionals facing such situations should prioritize their ethical obligations and commitment to providing objective, evidence-based testimony. The decision-making process should involve a clear understanding of the IME’s role as an independent expert, not an advocate. When confronted with pressure to deviate from objective findings or ethical standards, the professional should firmly but politely reiterate their commitment to impartiality and factual accuracy. If the pressure persists or involves unethical requests, seeking guidance from professional organizations or legal counsel specializing in medical-legal ethics may be advisable, and in extreme cases, withdrawal from the case might be necessary to maintain professional integrity.

This scenario presents a professional challenge because the independent medical examiner (IME) must accurately determine the appropriate type of medical evaluation to conduct, balancing the need for thoroughness with efficiency and cost-effectiveness, all while adhering to established ABIME guidelines and ethical principles. Mischaracterizing the evaluation type can lead to incomplete assessments, unnecessary costs, or a failure to meet the referral source’s needs, potentially impacting the claimant’s case and the IME’s professional reputation. Careful judgment is required to discern the specific information needed and the scope of examination necessary to provide a definitive opinion. The best approach involves conducting a comprehensive medical evaluation. This is correct because a comprehensive evaluation is designed to provide a broad and in-depth assessment of the claimant’s medical condition, history, and functional capacity. It is indicated when the referral source requires a thorough understanding of the claimant’s overall health status, the etiology and extent of their impairments, and their ability to perform work-related activities, especially when prior evaluations may be insufficient or when the case involves complex medical issues. This aligns with the ethical obligation of an IME to provide a complete and objective assessment based on all available relevant information, ensuring that no critical aspect of the claimant’s condition is overlooked. An approach that focuses solely on a focused medical evaluation would be incorrect if the referral source’s request or the claimant’s medical history indicates a need for a broader assessment. A focused evaluation is typically used to address specific questions or a particular aspect of a condition, and undertaking this when a comprehensive review is warranted would fail to provide the necessary depth of information, potentially leading to an incomplete or misleading opinion. This violates the ethical duty to provide a thorough and accurate assessment. Choosing to conduct only a follow-up medical evaluation when the initial referral clearly indicates a need for a new or comprehensive assessment would also be professionally unacceptable. A follow-up evaluation is intended to monitor the progress of a condition or the effectiveness of treatment after an initial evaluation. Initiating a follow-up without a prior comprehensive assessment by the same examiner or a clear indication from the referral source that this is appropriate would be a misinterpretation of the referral and an ethical failure to meet the requirements of the case. The professional reasoning process for similar situations should begin with a meticulous review of the referral request, paying close attention to the specific questions posed by the referral source and any accompanying documentation. The IME should then assess the claimant’s medical history and available records to determine the scope of information already present and identify any gaps. Based on this comprehensive understanding, the IME can then judiciously select the most appropriate type of evaluation—comprehensive, focused, or follow-up—that will best address the referral’s objectives while upholding ethical standards of thoroughness and objectivity.

Scenario Analysis: This scenario presents a common challenge for independent medical examiners (IMEs) in legal contexts: balancing the need for thoroughness and accuracy in medical record review with the specific demands and limitations imposed by a legal request. The challenge lies in interpreting the scope of the request, identifying relevant information, and presenting findings in a manner that is both legally sound and ethically defensible, all while adhering to professional standards and potential jurisdictional rules governing IMEs. The pressure to deliver a timely and comprehensive report without overstepping the bounds of the request requires careful judgment and a deep understanding of the role of medical records in legal proceedings. Correct Approach Analysis: The best professional practice involves a systematic and meticulous review of all provided medical records, cross-referencing them with the specific questions posed by the legal entity. This approach prioritizes identifying all relevant documentation that directly addresses the inquiry, such as treatment history, diagnostic findings, functional limitations, and prognosis. The examiner must then synthesize this information objectively, drawing conclusions solely based on the evidence within the records and their own medical expertise. This method ensures that the report is grounded in factual data, directly answers the legal questions, and avoids speculation or the inclusion of extraneous information. This aligns with the ethical obligation of an IME to provide an unbiased and evidence-based opinion within the defined scope of the examination. Incorrect Approaches Analysis: One incorrect approach is to focus solely on records that appear to support a particular outcome or narrative, while neglecting or downplaying contradictory or less favorable information. This selective review violates the ethical duty of impartiality and can lead to a biased and misleading report, undermining the integrity of the legal process. Another unacceptable approach is to include information or opinions that extend beyond the scope of the provided records or the specific questions asked. This overreach can introduce irrelevant data, create confusion, and potentially exceed the IME’s mandate, leading to legal challenges and a loss of credibility. Furthermore, failing to thoroughly review all provided documentation, perhaps due to time constraints or an assumption of irrelevance, risks omitting critical information that could significantly impact the legal determination. This oversight can be seen as professional negligence and a failure to meet the standard of care expected of an IME. Professional Reasoning: Professionals facing such situations should adopt a structured decision-making process. First, meticulously analyze the legal request to understand the precise questions being asked and the scope of information required. Second, conduct a comprehensive and unbiased review of all provided medical records, categorizing information by relevance to the posed questions. Third, synthesize the findings objectively, ensuring all conclusions are directly supported by the medical evidence. Fourth, draft the report, addressing each question directly and concisely, and clearly delineating any limitations of the review or the records. Finally, maintain meticulous documentation of the review process and the rationale for all conclusions. This systematic approach ensures accuracy, impartiality, and adherence to professional and legal standards.

This scenario presents a professional challenge because the independent medical examiner (IME) must reconcile conflicting diagnostic information from multiple sources, including the claimant’s treating physician and diagnostic imaging, while adhering to the ethical and regulatory standards governing independent medical examinations in the United States. The IME’s diagnostic reasoning and clinical judgment are paramount in forming an objective and evidence-based opinion that will inform subsequent claims management decisions. The core of the challenge lies in the potential for bias, the need for thoroughness, and the imperative to base conclusions solely on objective findings and established medical principles, as mandated by ethical guidelines for IMEs and relevant state medical board regulations concerning professional conduct and reporting. The best professional approach involves a comprehensive review of all available medical records, a thorough independent physical examination, and the integration of all findings into a coherent diagnostic impression. This approach prioritizes objectivity by considering all evidence, including potentially contradictory information, and systematically evaluating its reliability and relevance. The IME must then apply established diagnostic criteria and clinical reasoning to arrive at a conclusion that is supported by the totality of the evidence. This aligns with the ethical obligation of an IME to provide an unbiased, independent medical opinion based on sound medical principles and the facts of the case, as outlined by professional organizations like the American Medical Association (AMA) and implicitly required by state licensing boards to ensure competent and ethical medical practice. An approach that solely relies on the treating physician’s opinion without independent critical evaluation fails to uphold the IME’s role as an independent evaluator. This is ethically problematic as it abdicates the responsibility to form an independent judgment and may perpetuate any potential biases or diagnostic errors present in the prior opinions. It also fails to meet the expectation of a thorough and objective assessment that the requesting party relies upon. Another unacceptable approach is to selectively focus on diagnostic imaging findings while disregarding the claimant’s subjective complaints and the treating physician’s clinical observations. This selective interpretation can lead to an incomplete or skewed diagnostic picture, potentially misrepresenting the claimant’s condition and failing to address the full scope of their medical issues. It violates the principle of holistic patient assessment and can result in an inaccurate and unfair medical opinion. Furthermore, an approach that prematurely concludes a diagnosis based on limited information or without a systematic differential diagnosis process is professionally unsound. This haste can lead to diagnostic errors and undermines the credibility of the IME’s findings. It demonstrates a lack of due diligence and a failure to apply rigorous clinical reasoning, which is a cornerstone of responsible medical practice. The professional decision-making process for similar situations should involve a systematic approach: 1) Gather all relevant information. 2) Critically evaluate the quality and consistency of each piece of information. 3) Conduct a thorough independent examination. 4) Formulate a differential diagnosis. 5) Apply established diagnostic criteria and clinical reasoning to arrive at a final diagnosis, supported by objective findings and medical literature. 6) Clearly articulate the reasoning process and any limitations in the opinion.

Scenario Analysis: This scenario presents a common challenge in independent medical evaluations where a claimant’s subjective reporting of pain and functional limitations appears inconsistent with objective medical findings and their reported daily activities. The physician must navigate the ethical imperative to accurately assess impairment while avoiding bias, ensuring the claimant’s perspective is considered, and adhering to established guidelines for functional capacity evaluations. The challenge lies in reconciling potentially conflicting information to arrive at a fair and evidence-based impairment rating. Correct Approach Analysis: The best approach involves a comprehensive review of all available data, including the claimant’s self-report, objective medical findings, diagnostic imaging, and any functional capacity evaluation (FCE) results. This approach prioritizes a holistic assessment, seeking to understand the claimant’s experience within the context of objective evidence. It requires the physician to carefully consider the claimant’s reported limitations, explore potential reasons for discrepancies (e.g., fear avoidance, deconditioning, inconsistent effort during testing), and document the rationale for any conclusions drawn. The ABIME guidelines emphasize the importance of considering all relevant information and providing a well-supported opinion, which this comprehensive review facilitates. Incorrect Approaches Analysis: One incorrect approach is to solely rely on objective medical findings and dismiss the claimant’s subjective complaints due to perceived inconsistencies. This fails to acknowledge the subjective nature of pain and its impact on function, which is a critical component of impairment assessment. It can lead to an underestimation of impairment and a failure to meet the claimant’s needs, potentially violating ethical principles of patient-centered care and the ABIME’s directive to consider all relevant data. Another incorrect approach is to give undue weight to the claimant’s subjective reports without critically evaluating them against objective evidence and established functional capacity benchmarks. While claimant input is vital, unchecked reliance can lead to an overestimation of impairment, especially if there are factors like malingering or symptom magnification at play. This approach risks producing an inaccurate and unsupported impairment rating, deviating from the ABIME’s requirement for evidence-based conclusions. A third incorrect approach is to focus narrowly on a single diagnostic finding or test result without integrating it into the broader clinical picture. This reductionist view ignores the complex interplay of factors that contribute to an individual’s functional capacity and impairment. It can lead to a fragmented and incomplete assessment, failing to capture the true extent of the claimant’s limitations and violating the principle of a comprehensive evaluation. Professional Reasoning: Professionals should approach these situations by first establishing a clear understanding of the claimant’s reported symptoms and functional limitations. This should be followed by a thorough review of all objective medical data, including diagnostic tests and previous evaluations. The physician must then critically analyze any discrepancies between subjective reports and objective findings, considering potential contributing factors. The ABIME guidelines provide a framework for integrating this information, emphasizing the need for a well-reasoned and documented opinion that reflects the totality of the evidence. The goal is to achieve an impairment rating that is both accurate and ethically sound, reflecting the claimant’s actual functional capacity.

This scenario presents a professional challenge because the physician must reconcile potentially conflicting information from different sources regarding a patient’s injury, while adhering to the ABIME’s ethical and professional standards for independent medical evaluations. The core of the challenge lies in accurately assessing the pathophysiology of the injury and its impact on the patient’s functional capacity, ensuring the evaluation is objective and unbiased, and that the final report is comprehensive and defensible. Careful judgment is required to avoid diagnostic bias and to ensure that the evaluation is based on sound medical principles and evidence. The best professional approach involves a thorough and systematic review of all available medical records, a comprehensive physical examination, and the application of established medical knowledge to determine the underlying pathophysiology of the patient’s condition. This approach prioritizes objective findings and established medical science to form a conclusion about the injury’s mechanisms, its current state, and its functional implications. It aligns with the ABIME’s emphasis on evidence-based evaluations and the physician’s ethical obligation to provide an impartial assessment. By integrating all data points and applying a rigorous diagnostic process, the physician can accurately determine the pathophysiology and its sequelae, leading to a reliable impairment rating. An approach that relies solely on the patient’s subjective report without corroborating objective findings or a detailed review of prior medical history is professionally unacceptable. This fails to adhere to the principle of objective medical evaluation, as it gives undue weight to subjective complaints without independent verification. It risks misinterpreting the extent or nature of the injury, potentially leading to an inaccurate assessment of pathophysiology and functional impairment. Another professionally unacceptable approach is to selectively interpret diagnostic imaging results to support a pre-conceived notion of the injury’s severity. This demonstrates bias and a failure to conduct a balanced and objective review of all evidence. Medical evaluations must be based on a holistic interpretation of all diagnostic data, not on cherry-picking findings that align with a desired outcome. This violates the ethical duty of impartiality and the scientific integrity of the evaluation. Furthermore, an approach that dismisses the potential for pre-existing conditions to contribute to the current symptomatology without a thorough investigation is also professionally unsound. While the focus is on the injury, a comprehensive evaluation requires considering all factors that may influence the patient’s presentation and functional capacity. Ignoring potential contributing factors can lead to an incomplete understanding of the pathophysiology and an inaccurate assessment of the injury’s impact. The professional reasoning process for such situations should involve a commitment to objectivity, a systematic approach to data gathering and analysis, and a thorough understanding of the relevant medical literature and diagnostic criteria. Physicians should begin by defining the specific questions they need to answer regarding the pathophysiology. They should then gather all relevant information, critically evaluate its reliability and relevance, and synthesize it using established medical principles. Finally, they should formulate conclusions that are directly supported by the evidence and clearly articulated in the report, acknowledging any limitations or uncertainties.

The scenario presents a common challenge in independent medical evaluations: balancing the need for comprehensive documentation with the practical constraints of report writing and the ethical obligation to provide an objective, unbiased assessment. The core difficulty lies in ensuring that the report accurately reflects the claimant’s condition and the examiner’s findings without introducing extraneous information or subjective interpretations that could compromise its integrity or utility. The best approach involves meticulously documenting all relevant findings, including the claimant’s history, physical examination results, diagnostic test interpretations, and the rationale for conclusions. This documentation should be presented in a clear, organized, and objective manner, directly addressing the referral questions. The report must strictly adhere to the American Board of Independent Medical Examiners (ABIME) Code of Ethics and Standards of Practice, which emphasize accuracy, completeness, and impartiality. This includes clearly stating any limitations in the examination or available information and avoiding speculation or opinions beyond the scope of the examiner’s expertise. The focus is on factual reporting and evidence-based conclusions, ensuring the report serves its intended purpose for the requesting party. An approach that includes speculative opinions about the claimant’s future behavior or motivations, without direct evidence from the examination or objective data, is professionally unacceptable. This introduces bias and moves beyond the scope of a medical evaluation, potentially misleading the recipient of the report and violating ethical guidelines that prohibit unsubstantiated claims. Including extensive personal anecdotes or subjective interpretations of the claimant’s demeanor, unrelated to objective medical findings, is also professionally unacceptable. While observations of demeanor can sometimes inform the overall clinical picture, they should be presented factually and linked to medical relevance, not as narrative embellishments. This can detract from the report’s objectivity and introduce potential bias. Finally, omitting critical details from the claimant’s history or examination findings that are relevant to the referral questions, even if they do not support a particular conclusion, is professionally unacceptable. The ABIME standards require a complete and accurate representation of the findings, and selective omission undermines the integrity of the evaluation and the report. Professionals should employ a decision-making process that prioritizes adherence to established ethical codes and standards of practice. This involves a systematic review of the referral questions, a thorough and objective examination, meticulous documentation of all findings, and a clear, evidence-based articulation of conclusions. When in doubt about the relevance or inclusion of information, professionals should err on the side of factual reporting and consult ethical guidelines or experienced colleagues. The ultimate goal is to produce a report that is accurate, objective, and directly addresses the purpose of the independent medical examination.

The evaluation methodology shows a common challenge in independent medical evaluations (IMEs) where a treating physician’s medication prescription may conflict with the IME physician’s assessment of the patient’s condition and the medication’s appropriateness. This scenario is professionally challenging because the IME physician must balance respect for the treating physician’s clinical judgment with their own independent, objective assessment, all while adhering to ethical guidelines and the specific requirements of the IME process. The IME physician’s duty is to the integrity of the evaluation and the requesting party, not to the patient’s treating physician or the patient’s personal preferences. The best approach involves a thorough, objective review of all available medical records, including the treating physician’s notes and prescription history, and a comprehensive physical examination of the patient. The IME physician should then formulate an independent opinion regarding the medical necessity, appropriateness, and efficacy of the prescribed medication in relation to the patient’s diagnosed condition and functional limitations. If the IME physician concludes the medication is not medically necessary, is inappropriate, or is not being used effectively, they must clearly articulate the rationale for this conclusion in their report, citing objective findings and relevant medical literature or guidelines. This approach upholds the IME physician’s duty of objectivity and provides a well-supported, evidence-based opinion. An incorrect approach would be to automatically defer to the treating physician’s prescription without independent critical evaluation, even if the IME physician has objective findings suggesting the medication is not indicated or is causing adverse effects. This failure to exercise independent professional judgment undermines the purpose of the IME and could lead to an inaccurate assessment of the patient’s condition and needs. Another incorrect approach would be to dismiss the treating physician’s prescription solely based on a difference of opinion or a perceived lack of benefit without a systematic, evidence-based analysis. The IME physician must provide a clear, documented rationale for any disagreement, demonstrating that the conclusion is based on objective medical evidence and not personal bias. A further incorrect approach would be to recommend discontinuing the medication without considering potential withdrawal symptoms or the patient’s subjective experience, or to recommend alternative medications without a clear understanding of the patient’s response to current treatment and potential contraindications. This demonstrates a lack of comprehensive patient assessment and a failure to consider the practical implications of medication management. Professionals should approach such situations by prioritizing objective evidence and independent analysis. The decision-making process should involve: 1) gathering and meticulously reviewing all relevant medical information; 2) conducting a thorough patient examination; 3) critically evaluating the appropriateness and efficacy of current treatments, including medications, based on established medical standards and the patient’s specific clinical presentation; 4) forming an independent opinion supported by clear, objective reasoning; and 5) documenting all findings and conclusions transparently and comprehensively in the IME report.